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Dilated Cardiomyopathy: A Comprehensive Approach to Diagnosis and Risk Stratification
André Ferreira1, Vera Ferreira1, Miguel Marques Antunes1
1Cardiology Service, Hospital Santa Marta, Centro Hospitalar Universitário de Lisboa Central, 1169-050 Lisbon, Portugal.
Insights
Dilated cardiomyopathy (DCM) is a common heart failure cause. New imaging and genetic tests improve diagnosis and risk stratification for better patient outcomes.
Area of Science:
- Cardiology
- Genetics
- Medical Imaging
Background:
- Dilated cardiomyopathy (DCM) is a primary cause of non-ischemic heart failure with high mortality.
- Early structural cardiac abnormalities and arrhythmogenic phenotypes present diagnostic challenges.
- Current therapies have limited impact on DCM outcomes.
Purpose of the Study:
- To propose a systematic approach for DCM evaluation.
- To improve diagnostic pathways and arrhythmic risk stratification.
- To integrate novel diagnostic tools for better clinical decision-making.
Main Methods:
- Review of recent advancements in cardiac magnetic resonance (CMR) and genetic testing.
- Focus on a structured approach to DCM diagnosis and risk assessment.
- Integration of imaging and genetic data for clinical guidance.
Main Results:
- Cardiac magnetic resonance and genetic testing offer new insights into DCM.
- Improved diagnostic accuracy for differentiating DCM from similar conditions.
- Enhanced identification of patients at high risk for arrhythmias and poor treatment response.
Conclusions:
- A comprehensive diagnostic strategy incorporating advanced imaging and genetics is crucial for DCM.
- Structured risk stratification aids in personalized treatment and improved patient outcomes.
- Novel approaches are essential for managing the complexities of dilated cardiomyopathy.
Abstract:
Dilated cardiomyopathy (DCM) represents one of the most common causes of non-ischemic heart failure, characterised by ventricular dilation alongside systolic dysfunction. Despite advances in therapy, DCM mortality rates remain high, and it is one of the leading causes of heart transplantation. It was recently recognised that many patients present minor structural cardiac abnormalities and express different arrhythmogenic phenotypes before overt heart-failure symptoms. This has raised several diagnostic and management challenges, including the differential diagnosis with other phenotypically similar conditions, the identification of patients at increased risk of malignant arrhythmias, and of those who will have a worse response to medical therapy. Recent developments in complementary diagnostic procedures, namely cardiac magnetic resonance and genetic testing, have shed new light on DCM understanding and management. The present review proposes a comprehensive and systematic approach to evaluating DCM, focusing on an improved diagnostic pathway and a structured stratification of arrhythmic risk that incorporates novel imaging modalities and genetic test results, which are critical for guiding clinical decision-making and improving outcomes.
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